Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | D5160 | AZ |
NPI | 1043214448 |
---|---|
Provider Name | Dr. Jaleh Tina Keyhani |
First Address | Scottsdale, AZ 85260-4929 |
Second Address | Phoenix, AZ 85014-5403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2005 |
Last Update Date | 30/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
529604 | (05) | AZ |
U66271 | (02) | AZ |